Social-cognitive predictors of physical activity initiation in type 2 diabetes following diabetes self-management education : application of the health action process approach.

Abstract

Type 2 diabetes presents a public health crisis and a global pandemic. Successful management of diabetes requires engagement in a daily regimen of self-care behaviors to achieve optimal glycemic control and to reduce the severity of diabetes-related complications. Regular engagement in physical activity has been demonstrated to improve glycemic control and overall quality of life among patients with diabetes. Diabetes self-management education (DSME) has become the hallmark for instructing patients with diabetes to engage in physical activity, yet physical activity patterns of DSME patients remains largely unknown. Further, it is unclear what factors could account for such behavior change in the DSME setting. Social-cognitive models of health behavior have attempted to explain behavior change such as physical activity initiation. One model, the Health Action Process Approach (HAPA), provides a parsimonious framework for understanding this process. The HAPA organizes key social-cognitive factors into a motivational stage, where a behavioral intention is formed, and a volitional stage, where self-regulatory processes such as action planning mediate the intention-behavior relationship, thereby translating intention into action. Using the HAPA as a theoretical framework, the present study sought to examine the key social-cognitive determinants of physical activity initiation among patients with type 2 diabetes after they participated in DSME. A longitudinal, multi-site prospective study design utilized written and telephone based surveys to assess HAPA constructs and physical activity in a DSME population. Participants were 152 adults with type 2 diabetes attending DSME classes in a mid-west metropolitan city. Results of this study revealed that several key social-cognitive factors, as conceptualized by the HAP A's motivational stage, predicted the formation of a behavioral intention to engage in physical activity. Findings on the HAPA volitional stage constructs indicated that only behavioral intention predicted which participants met the minimum amounts of physical activity promoted in DSME. Additionally, the present study revealed physical activity initiation remains a problem among DSME participants. Future research is recommended to clarify the causal role and pathways of social-cognitive factors in the HAP A model to better understand physical activity initiation within the DSME population.

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